Saturday, September 10, 2011

the lessons we are told and the ones we learn the hard way

 In the long process of getting into vet school (my process has to be the longest on record, I sound like I am proud of that, really, I am chuckling, it was so ridiculous), I had to meet the stringent, grueling, and  exceedingly high expectations set forth by the Veterinary Admissions Committee. I needed to have high grades (another story in itself), a few letters of reference, a GRE score that was almost unattainable, a work history that was longer than the other applicants I was up against, and some experience in a laboratory setting for the purpose of research. It took me many years to get that small list up to par with the rest of the hopefuls. To help bulk up my work history resume I started calling all of the veterinary clinics around me. I had to make a lot of calls. I am sure most of the clinics thought I sounded like a loon. I was asking if I could come in and volunteer my time at their clinic. But there were few stipulations and problems that I had before I could start volunteering. Like, for example, I still had a job, a crazy unpredictable job.
I went to sea for a living, as a merchant seaman. (I know not a common transition, Merchant Mariner to Veterinarian). I was working for AT& T on their fiber optic cable ships stationed in Baltimore MD. I was worked on the ship 7 days a week from 8 am to 4 pm, and then I would head off to the veterinary clinic. But the ship was on standby, which meant that if any undersea cable in the Northern Atlantic Ocean needed any fixing we had 24 hrs to get our ship shipshape and lines aboard, and be heading out to sea. We never knew how long we would be gone, and we never knew when the call would come. In other words I wanted to help but I might be very unreliable. After a few random calls I landed an opportunity to volunteer at a vaccine clinic. It was at that time a very novel idea. The clinic was open 2 hours three times a week for walk-in appointments. The clinic could only provide minimal services, primarily vaccines and examinations, but  I immediately loved this clinic. The medicine was fast and furious. The clients were from all sides of the spectrums, (because I guess everyone is always trying to save a buck?) and the cases were just as varied. Sometimes, most of the time, it was just “hello,” “nice to meet you,” happy healthy cat/dog, place said cat/dog on the examination table, pop vaccine in the butt and then call out “Next!”  It was fast, and furious, and fun. But there wasn’t a lot of intense medicine involved, (not that the admissions committee was going to find out).
The owner of the vaccine clinic was Dr. Lou Applefeld. He was a tall, dark, handsome, smart, witty, and friendly man. I loved him instantly too. He was great fun to be around, and a great mentor to have. I got lucky. I stayed volunteering there for about 3 years, and I actually learned as much about veterinary vaccines as I did about being a veterinarian and business owner. He was patient, kind and generous with both his time and advice. He loved veterinary medicine and his patients but he was tired of struggling between the ability to make a living reflective of a doctor/veterinary expert, and the pressures owners placed on him to give away his time, expertise, goods, and services. He told me over and over that the amount of time, effort, and money you had to put into the process of getting a DVM wasn’t worth it in the end. He pleaded with me to change my mind. He was trying to save me from the internal frustrations and challenges that his 40 years had given him. It was a lost cause. I had wanted this for too long and I had invested too much into it already, that and I am destructively stubborn. I had to learn this lesson on my own.
In 2001 I started vet school at Virginia-Maryland Regional College of Veterinary Medicine. I was so proud. It seemed like it was the culmination of a lifetime of effort. (I was an old lady comparatively speaking to the rest of my class, 31, (grimace, shock, horror).  It was four long hard years of school. And let me tell all of you who are debating starting vet school it’s really hard to do anything else while you are trying to get through.
 I had the support of a wonderful man that I had just met 3 months before vet school started. The odds of any relationship, especially a new one are not stacked in your favor, but it turns out he is almost as stubborn as I am. So he stuck with me for the 4 years of vet school, drove 4 hours each way every weekend just to hold my hand, hand me hankies, clean my house, and buy the weeks’ worth of groceries. He really helped me get through vet school, and I am not sure I could have done it without him. (Thanks honey, I owe you a million).
Fast forward 10 years or so and now I am in about the same position Dr. Applefeld was, (well minus the 30 years of experience) and I now understand why he harped on me as hard as he did. And damn him if he wasn’t right. It is a difficult career to pick. Juggling the pressures of making a living, looking into the eyes of a patient whose life depends on someone intervening on their behalf, and in many cases an owner who cannot, or will not pay for their care. Veterinarians either stop caring, stop listening, go broke, or burn out. I struggle to stay standing as I walk the high wire in between all of these. I tell myself everyday that the last part of me that I will let go is my sanity, followed by my compassion, and lastly my business. (But if my husband asks please tell him the reverse order). 
Here is one of the stories where I got burned by my desire to do the right thing, take care of a critical pet and learn another lesson the hard way. One of my technicians came to me one day to tell me that her boyfriend’s ex-wife had her dog in the emergency hospital and she could not afford the care there that her dog needed. I told her that if she couldn’t afford the emergency clinic and her dog needed care she should bring it over for us to look at. A short time later I met the ex-Zaremba and her very sweet pit bull mix dog Freckles. Freckle’s was in a terrible state when I met her. She was obese, unable to walk, lethargic, and very ill. She was one of those cases that break your heart in 5 minutes. For as sweet and gentle as she was she had essentially been ignored all medical care for at least 4 years. The list of possible diseases that could be causing/contributing to her current state was long and the investigation to get to her diagnosis was not going to be cheap. I discussed all of this with her owner and she explained to me that she would do whatever it took to get her well. We began the long process to identify the cause(s) of her condition. Within 30 minutes we knew the following; She had a terrible case of Lyme disease (if left untreated, or if found in the advanced state, this will often be fatal), She had a very large distended urinary bladder that might burst at any moment and could kill her if not resolved immediately. She was not spayed (leaving the real possibility of having a pyometra, or infection of the uterus, another big killer is not treated immediately). A very low protein, (also life threatening), and she had a severe case of both whipworms and hookworms. I made it very clear to her owner that she needed immediate emergency care and that regardless of all the treatment and care she was given she may still not survive. Her prognosis was grave and her condition severe. Her owner Ms. Zaremba pleaded with me to do everything I could for her and she pledged to pay for her care even if it meant making payments on her account for months to come. I provided her with an estimate of about $1000 which I hoped would take cover of her three days of hospitalization and care.
After three intense days of aggressive medical care, multiple x-rays, blood work, a urinary catheter, and hospitalization Freckles walked out of JVC a happy healthy dog. We started her vaccines and spayed her a few weeks later. Everyone was relieved that she was such a wonderful success story. She remains one of the happiest patients we have ever cared for. It was wonderful to see how incredibly resilient and miraculous her recovery was. That kind of case is the payback all vets live for. For as many terrible endings it is the one or two miraculous cases that keep us going.
But back to Dr. Applefeld. After Freckles received all of her care, she had amassed a bill of over $1500 dollars. In the very beginning, when Freckles still needed follow up care, Ms. Zaremba followed through with her established payment plans, but after we stopped seeing Freckles we also stopped seeing payments. To this day I have not been reimbursed for her care. Do I regret it? No, I did the right thing for a wonderful dog. Do I do payment plans anymore? Hell NO! They don’t work, and I need to maintain some tactics to preserve my burn out potential.
So Ms. Zaremba I know that you are still out there, (there are also a few others, you know who you are, that took advantage of JVC) I hope that someday your sense of responsibility and descency bring you back to our door to make things right. And I ask myself do these people exist in every small business? Yes, no doubt. Do I expect people to be fair and descent still? Yes. I still believe in people, I just don’t put the staff’s payroll on the line for them.
 It is an ever evolving process to figure out how to walk the line. I wish I had Dr. Applefeld around to get advice, but very sadly he passed away a few years ago. He had 6 years of retirement, which he enjoyed much more than working, and I feel that the words of advice and his life lessons live on with me. I remind myself to enjoy the successes, learn from the failures, love my patients as if they were my own pets, and follow my heart. That and I never deny care,( because I won’t let myself become a hardened uncompassionate soul), but these days I take collateral, multiple forms of id, signed promissory notes and I have a great collections agency. Or you can sign your pet over to JVC and then we can provide all of the needed care without the frustration of trying to collect payment afterwards. So far it has worked. But it means we always have a pet up for adoption, and jewelry in the collateral bag. If you see the neon sign in the door with the three balls and the “pawn broker” words in the window you know that I have fallen one more tier down the ladder of desperation. I hope that it is still a long way down. I miss you Lou, and I say a big loud “THANKS!” I am a better person, veterinarian, and business owner because of you. I am very grateful.

No comments:

Post a Comment